Healthcare Provider Details

I. General information

NPI: 1417188905
Provider Name (Legal Business Name): HUMC CARDIOVASCULAR PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRANK W. BURR BOULEVARD SUITE 22
TEANECK NJ
07666-6700
US

IV. Provider business mailing address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

V. Phone/Fax

Practice location:
  • Phone: 201-907-0442
  • Fax: 201-692-3263
Mailing address:
  • Phone: 201-336-8406
  • Fax: 201-343-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARILYN EMERSON
Title or Position: DIRECTOR OF PROFESSIONAL SERVICES
Credential:
Phone: 201-996-5633